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Herniorrafia inguinal em crian as: valor da anestesia local associada
Minossi José Guilherme,Pican?o Hemerson César,Paulucci Paulo Roberto Vasconcelos,Carvalho Marcelo Ant?nio de
Arquivos de Gastroenterologia , 2002,
Abstract: OBJETIVO: Descrever uma técnica de anestesia local no tratamento de hérnias inguinais em crian as. MéTODO: Foram operadas 48 crian as com hérnias inguinais sob anestesia local na Santa Casa de Misericórdia de Cerqueira César, SP, sendo 34 do sexo masculino e 14 do sexo feminino, com idades entre 3 meses e 12 anos. Apenas quatro crian as tinham hérnia bilateral. A anestesia local foi realizada com lidocaína a 1% na dose de 5 mg/kg de peso através do bloqueio dos nervos abdominogenitais próximos à espinha ilíaca antero-superior, à altura do anel inguinal externo e na pele ao redor da incis o. A seda o foi feita com cetamina na dose de 1 a 2 mg/kg e diazepam 0,2 a 0,4 mg/kg de peso. RESULTADOS: Todas as cirurgias puderam ser realizadas com tranqüilidade com este método, com exce o de uma crian a em que o bloqueio n o foi efetivo e a anestesia complementada com inala o de halogenado, sob máscara. Como complica es pós-operatórias, ocorreram três hematomas, sendo um de parede e dois em bolsa escrotal, todos com boa evolu o. CONCLUS ES: O uso da anestesia local associada à seda o é procedimento simples e seguro para realizar herniorrafias inguinais em crian as.
Herniorrafia inguinal em crian?as: valor da anestesia local associada
Minossi, José Guilherme;Pican?o, Hemerson César;Paulucci, Paulo Roberto Vasconcelos;Carvalho, Marcelo Ant?nio de;Vendites, Soraya;
Arquivos de Gastroenterologia , 2002, DOI: 10.1590/S0004-28032002000300012
Abstract: aim: to describe an anesthetic technique, as well as the results of surgical treatment of the inguinal hernia in children. patients/methods: forty-eight patients were submitted to inguinal hernia repair under local anesthesia at "santa casa de misericórdia de cerqueira césar", state of s?o paulo, brazil. there were 34 male and 14 female patients, range from 3 months to 12 years old. local anesthesia was performed with a dose of 5 mg/kg body weight of 1% lidocaine through iliohypogastric and ilioinguinal nerve blocks, medially to the anterior superior iliac spine, and at level of the pubic tubercle. sedation was done with an association of ketamine (1 to 2 mg/kg) and diazepam (0,2 to 0,4 mg/kg). results: in all patients except one the procedure was done without complications. in that patient the local anesthesia was not effective and was followed by inhalatory anesthesia. surgical complications (blood collections) were observed in three patients: two at the scrotum and one at subcutaneous, with good evolution. conclusions: we conclude that the use of local anesthesia associated to sedative is a simple and safe procedure for the inguinal hernia repair in children.
Herniorrafia inguinal com anestesia local em regime ambulatorial
Ribeiro, Flavio Antonio de Sá;Padron, Fernanda;Castro, Tiago Duarte Magalh?es;Torres Filho, Lucio Carlos de Azevedo;Fernandes, Baltazar de Araujo;
Revista do Colégio Brasileiro de Cirurgi?es , 2010, DOI: 10.1590/S0100-69912010000600004
Abstract: objective: to demonstrate the feasibility of inguinal hernia repair with local anesthesia in an outpatient regime, with safety, efficacy and short learning curve. methods: we prospectively evaluated 454 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between november 2004 and august 2008. of the total number of hernias surgically treated in this period, 285 were operated on the right, 163 on the left and six bilateral. we used clinical, surgical and psychosocial criteria for inclusion in the procedure. the parameters for exclusion were complex, irreducible or recurrent hernia, obesity (bmi greater than 30 kg/m2), patient's refusal and psychiatric disorder. all patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. results: all operations were completed successfully. in no case there was need to change the anesthetic method. surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. intra-operative complications amounted to approximately 2.64% (12/454). there was no need for hospital admissions greater than 24 hours. conclusion: the procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.
Uso do tramadol venoso e subcutaneo em herniorrafia inguinal: estudo comparativo
Santos, Talita Oliveira Dias dos;Estrela, Tomaz Gonzalez;Azevedo, Vera Lucia Fernandes de;Oliveira, Onofre Eduardo Carvalho de;Oliveira Júnior, Gildásio;Figueiredo, Gilvan da Silva;
Revista Brasileira de Anestesiologia , 2010, DOI: 10.1590/S0034-70942010000500008
Abstract: background and objectives: inguinal herniorrhaphy is one of the most common surgeries in men. neuroaxis block is the anesthetic technique used more often and in the majority of the cases the patient is ready to be discharged from the hospital a few hours after the procedure, as long as satisfactory analgesia is present and nausea and vomiting are absent. tramadol is an analgesic drug that can be used in postoperative analgesia, but it has important side effects, such as nausea and vomiting whose incidence can range from 0% to 50%. the objective of the present study was to compare the incidence of nausea and vomiting and the quality of postoperative analgesia of subcutaneous and intravenous tramadol in patients undergoing inguinal herniorrhaphy. methods: this is a prospective study with 30 patients undergoing inguinal herniorrhaphy. patients were divided into two groups: group c (n = 15) received 1.5 mg.kg-1 of subcutaneous tramadol, and group v (n = 15) received 1.5 mg.kg-1 of intravenous tramadol. all patients underwent continuous epidural anesthesia with 0.5% levobupivacaine. anthropometric data, quality of analgesia, and the development of postoperative nausea and vomiting in the first eight hours were recorded. results: statistically significant differences were not observed between both groups for anthropometric data, quality of analgesia, and the development of nausea and vomiting. conclusions: the present study demonstrates the absence of statistically significant differences regarding the incidence of nausea and vomiting and quality of analgesia when using intravenous and subcutaneous tramadol
Fatores de risco para raquianestesia em recém-nascidos pré-termo submetidos a herniorrafia inguinal
Shenkman, Ze'ev;Erez, Ilan;Freud, Enrique;Arnon, Shmuel;
Jornal de Pediatria , 2012, DOI: 10.2223/JPED.2185
Abstract: objectives: to investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. times to resumption of oral feeding and to home discharge were also evaluated. methods: perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center. results: the study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [or] = 3.2, 95% confidence interval [95%ci] 2.8-5.3; p = 0.01) and periventricular leukomalacia (or = 2.8, 95%ci 2.1-4.9; p = 0.03). conclusions: spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.
Atividade preemptiva da infiltra??o da incis?o com ropivacaína a 0,75%, em pacientes submetidos à herniorrafia inguinal
Carvalho, André Laranjeira de;Castellana, Fábio Bonini;Gatto, Bruno Emanuel Oliva;Muraro, Silvia Katlauskas;Schiavuzzo, Fabio Augusto;Ashmawi, Hazem Adel;Vieira, Joaquim Edson;Utiyama, Edivaldo;Posso, Irimar de Paula;
Revista Dor , 2011, DOI: 10.1590/S1806-00132011000400007
Abstract: background and objectives: the effectiveness of preemptive analgesia as compared to the conventional regimen for postoperative pain control is still controversial. this study aimed at evaluating the effectiveness of local infiltration with 0.75% ropivacaine before and after the incision of inguinal hernia repair surgeries in postoperative pain intensity, analgesics consumption and time elapsed for first analgesic dose request. method: after the institutional research ethics committee approval, 60 patients, physical status p1 or p2, aged between 15 and 65 years, submitted to inguinal hernia repair under general anesthesia with isoflurane and fentanyl were randomly distributed in three groups: a - skin, subcutaneous and muscle infiltration before incision with 2 mg/kg of 0.75% ropivacaine; d - skin, subcutaneous and muscle infiltration after incision with 2 mg/kg of 0.75% ropivacaine; and c - control group, without infiltration. all patients received dipirone (2 g), 30 minutes before the end of anesthesia. a patient-controlled analgesia pump with morphine was used after anesthetic recovery. pain intensity with visual analog scale, total morphine consumption and time for the first morphine dose request were evaluated during 24 hours. results: morphine consumption was significantly lower in the a group (1.5 mg) as compared to the d group (5.5 mg) or to the control group (17 mg). time for first morphine dose request was significantly longer for the a group and pain intensity was lower in all moments as compared to c group and in the last 18 h as compared to the group. conclusion: preoperative incision infiltration with ropivacaine significantly decreases postoperative pain intensity and morphine consumption and delays the time for first morphine dose request.
Resultados imediatos da herniorrafia inguinal com anestesia local associada com seda o
Lima Neto Edgar Valente de,Goldenberg Alberto,Jucá Mário Jorge
Acta Cirurgica Brasileira , 2003,
Abstract: OBJETIVO: Avaliar os resultados imediatos da herniorrafia inguinal com anestesia local associada com seda o. MéTODOS: Foram operados 30 pacientes portadores de hérnia inguinal, sendo 26 (86,6%) do sexo masculino e 4 (13,4) do sexo feminino. Os anestésicos utilizados foram lidocaína a 1% e bupivacaína a 0,5% sem adrenalina, tendo sido adicionado 1mL de bicarbonato de sódio para cada 9mL da solu o anestésica. A seda o foi realizada com midazolan. As hérnias mais freqüentes, de acordo com a classifica o de Nyhus, foram as do tipo I, encontradas em 16 (53,3%) pacientes. Praticou-se o reparo da parede posterior a em 17 (56,6%) e em 13 (43,2%) o reparo com prótese. Para a análise estatística utilizou-se o teste de McNemar para avaliar a correla o entre os escores de dor na escala E.V.A. agrupada. RESULTADOS: Em nenhum paciente houve necessidade de mudan a da técnica anestésica. Entre as complica es, observaram-se: 1 (3,3%) hematoma; 1 (3,3%) sangramento e 1 (3,3%) infec o da ferida operatória. A deambula o foi precoce em 28 (93,3%) pacientes, assim como a alimenta o oral. O tempo de interna o médio foi 18 horas, e o escore de dor na escala visual analógica (E.V.A.) foi menor ou igual a 3 em 80% dos pacientes. CONCLUS O: A anestesia local com seda o é um método seguro, eficaz, com baixos índices de complica es imediatas, e alto índice de satisfa o para pacientes selecionados, portadores de hérnia inguinal.
Se debe fijar la malla durante una herniorrafia inguinal? Should mesh prosthesis be fixed in inguinal herniorraphy?
Luis Carlos Domínguez,álvaro Sanabria,Neil Valentín Vega,Camilo Osorio
Revista Colombiana de Cirugía , 2012,
Abstract: Introducción. La fijación de la malla durante una herniorrafia inguinal ha sido recomendada rutinariamente. La información disponible es controversial. En este estudio se hace una revisión crítica de la literatura científica, evaluando la efectividad clínica de esta intervención en cirugía laparoscópica y abierta (técnica de Lichtenstein). Métodos. Se hizo una búsqueda de la literatura científica siguiendo la metodología BET (Best Evidence Topic), para identificar artículos que compararan fijar contra no fijar la malla durante una herniorrafia inguinal. Los artículos se revisaron según los criterios de apreciación de la Journal of the American Medical Association (JAMA). Se extrajeron los datos de la efectividad de la intervención y se analizaron resultados primarios como reproducción, dolor posoperatorio, infección, seroma y hematoma. Se analizaron como resultados secundarios costo, tiempo de estancia hospitalaria, retorno laboral y tiempo quirúrgico. Resultados. Se encontraron una revisión sistemática de la literatura científica y nueve estudios de asignación aleatoria. En herniorrafia totalmente extraperitoneal, transabdominal preperitoneal y abierta, no existe diferencia en la frecuencia de reproducción, infección, seroma ni hematoma. La presencia de dolor posoperatorio disminuye tardíamente cuando no se fija la malla, tanto en herniorrafia abierta como laparoscópica. En herniorrafia laparoscópica el tiempo de incapacidad no disminuye si se fija la malla. Fijar la malla incrementa el costo y el tiempo quirúrgico. Conclusiones. La fijación de la malla puede omitirse en herniorrafia laparoscópica totalmente extraperitoneal, en la transabdominal preperitoneal y en la abierta por vía anterior (Lichtenstein). La principal ventaja de no fijar la malla, documentada en los estudios disponibles, tiene que ver con la reducción del dolor posoperatorio crónico, sin que exista diferencia en la tasa de reproducción. No hay información disponible sobre esta intervención en otros tipos de herniorrafia abierta, como la preperitoneal (Nyhus). Introduction / aims: Mesh fixation in groin hernia repair has been recommended routinely; however there is pertinent controversial information. In this study we review the clinical effectiveness of the intervention in open (Lichtenstein repair) and laparoscopic repair. Methods: We used a Best Bets methodology to identify clinical trials comparing mesh fixation versus no mesh fixation during inguinal herniorraphy. Studies were evaluated according with JAMA criteria. Information about clinical effectiveness was extracted from artic
Herniorrafia inguinal com anestesia locorregional - (uso de ropivacaína)
Skinovsky, James;Sigwalt, Marcos Fabiano;Bertinato, Luciane Paludo;Chibata, Mauricio;Moreira, Letícia Maria Schimtt;Granzotto, Paula Carolina Dambros;
Revista do Colégio Brasileiro de Cirurgi?es , 2006, DOI: 10.1590/S0100-69912006000400006
Abstract: background: the goal of this study is to report the efficiency and safety of inguinal herniorraphy using locoregional anesthesia with ropivacaine, describing the technique, its indications and limitations. methods: inguinal herniorraphy was performed in 50 patients, between january and december, 2005, using locoregional anesthesia with ropivacaine, at the red cross - unicenp universitary hospital, in curitiba, brazil. the herniorraphy tension free technique was used. age, sex and hernia type, using the nyhus hernia classification were analysed. results: it there were no side effects related to the anesthesic drug postoperative complications were mild and had adequate clinical solutions. conclusion: the authors concluded that herniorraphy using locoregional anesthesia, with the use of ropivacaine and sedation, is an adequate procedure, with remarkable benefits for the patients. they also suggest that, with the contribution of new future studies, the brazilian surgical community should consider this technique as a routine in our environment.
Herniorrafia inguinal: Técnica por sobrecapas de Fascia Transversalis
Goderich Lalán,José Miguel; Goderich López,Danisela;
Revista Cubana de Cirug?-a , 1997,
Abstract: a descriptive, prospective, observational, and longitudinal study was performed to evaluate the results obtained with the application of a technique for the repair of inguinal hernia (the author's original technique) by overlayers of fascia transversalis, in which the first layer is copped with the use of continuos suture from the projection of the pubic tubercle until the obliteration of the deep inguinal rign, creating a second layer when copping the aponeurotic arch of the transverse to the iliopubic eminence. after a follow-up longer than 10 years, it was proved that out of 1 475 patients, only 1,2 % presented with recurrences. relapses were more frequent in males, in indirect hernias and in patients over 45 years of age. the greatest number of recurrences occurred between the first and the third year after the operation. it is recommended to introduce this new technique within the surgical practice and to comply with the indications for the procedure made by the author
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